Healthcare Provider Details

I. General information

NPI: 1669658365
Provider Name (Legal Business Name): K.C.D.C.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W MAIN ST
LEBANON OH
45036-9173
US

IV. Provider business mailing address

950 W MAIN ST
LEBANON OH
45036-9173
US

V. Phone/Fax

Practice location:
  • Phone: 513-932-5024
  • Fax: 513-932-5531
Mailing address:
  • Phone: 513-932-5024
  • Fax: 513-932-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number852
License Number StateOH

VIII. Authorized Official

Name: DR. KENT C FOX
Title or Position: OWNER
Credential: DC
Phone: 513-932-5024